DEMENTIA. The broad term used for a syndrome that is characterized by a slowly progressive cognitive decline. Formerly called organic brain syndrome ( OBS ) and chronic brain syndrome ( CBS ), dementia represents a global impairment of intellectual function and is generally chronic and progressive. There are many types of dementia, the most common being, Alzheimer’s disease. Multi-infarct dementia, the second most common dementia, is a vascular disorder and accounts for twenty percent to twenty five percent of all dementias.
Whereas, dementia is a chronic, progressive disorder, delirium, is an acute state of confusion. Delirium also differs from dementia in that it is usually short-term and reversible within three weeks. It is often seen among older adults in a hospital setting or in a setting with which they are unfamiliar. Behavior typically fits into one or two categories; hyperactivity ( most common ) or hypoactivity ( Ignatavicius, 1999). Hyperactive clients may try to climb out of bed or pull out invasive catheters ( e. g. , urinary catheters or intravenous cannulas ), or they may become quit agitated and combative.
Hypoactive clients are quiet, apathetic, and withdrawn. Wakefield ( 2000 ) found that most nurses in her study did not realized that acutely confused older adults can be quiet. Multiple factors can cause delirium, including the following: Medication ( especially anti cholinergic drugs ) Metabolic disturbances Infections Surgical operations Circulatory, renal, and pulmonary disorders Nutritional deficiencies Major loss Acutely confused clients who are discharged from the hospital are at an increased risk for functional decline, false, and incontinence (Wakefield, 2002).
Therefore nurse should assess all their clients for acute confusion. A number of assessment tools have been developed, including the Confusion Assessment Method (CAM), Delirium Rating Scale (DRS) and NEECHAM Confusion Skill. CONCLUSION Nurses in most adult healthcare settings encounter the challenges of caring for both health and ill older adults. In view of the rapidly increasing older population, especially the over-85 aged group, nurses in many settings are specializing in gerontologic nursing and geriatric case management.
Nurses can practice this specialties in acute care, long-term care and community based settings. Just as nurses can achieve certification in medical-surgical nursing, they can became certified in gerontologic nursing or case management. The American Nurses Credentialing Center (ANCC), provides three gerontology examinations for the certification of those who qualify: gerontologic nurse, gerontologic clinical specialist, and gerontologic nurse practitioner.
The ANCC also offers a nursing case management examination that is broad, base and not specific for geriatric case management. Other professional organization also certifies case managers, including geriatric case managers.
References:
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